Calvarial lesions: overview of imaging features and neurosurgical management

Abstract

Calvarial lesions are rare and can present as a variety of different diseases. The lesions can be palpable on the skin and cause local pain and paraesthesia and, depending on the location, neurological deficits can also occur. This research aims to present an overview of typical imaging features as well as neurosurgical management. We examined the charts of patients who underwent surgery on a calvarial lesion in our department between 2004 and 2017 (n=133). Retrospectively, the pre-, intra-, and postoperative data were analyzed with morphological and histological findings and compared with each other. Pain, swelling, cosmetically disturbing, and neurological deficits were the main complaints. Seventy-seven lesions were limited to the bone, while another 56 lesions showed an infiltrating growth in the adjacent tissue. Depending on the clinical signs and suspected diagnosis, a biopsy, a partial removal, or a complete resection was performed. Histiocytosis (n=20), meningiomas (n=20), metastases (n=19), and osteomas (n=16) were the most common lesions. Fibrous dysplasia (n=6) and intraosseous hemangioma (n=9) were less common; other lesions were present only in isolated cases. Imaging features may suggest the lesion to be benign or malignant, but the diagnosis can be only confirmed by histological examination. The surgical strategy depends on the complaints, location of the lesion, and suspected diagnosis. Adjuvant treatment should be initiated according to the histological findings.

Calvarial Lesions: En-bloc Resection Is a Safe Surgical Procedure

“…Extraosseous manifestations may be present such as café au lait spots and endocrinologic disturbances (McCune-Albright syndrome) (15) . Agreeing with Nasi-Kordhishti et al (10) , we recommend surgery in the monostotic type, however conservative treatment with analgesics and bisphosphonates is used for the polyostotic type and surgery is indicated only to relieve compression of important structures.…”

“…Endosteal erosions (scalloping) and slight expansion beyond outer and inner tables reflects the characteristic "hole within a hole" and "beveled edges" signs (9) . MRI brain shows a homogeneous contrast enhancement limited to the bone (10) . We agree with Samara et al, that staging is an important step after removal of eosinophilic granuloma.…”

Calvarial Metastasis with Dural Sinus Invasion: A Case Report

“…Invasive metastases can manifest as headache, vomiting, or even neurological deficits (Harrison et al, 2018;Nasi-Kordhishti et al, 2021;Newton, 2008;Ozgiray et al, 2016).…”

“…Only a minority of patients with skull metastases are candidates for surgical resection. Complete gross total resection is associated with a prolonged survival rate (Harrison et al, 2018;Nasi-Kordhishti et al, 2021). The tumor can be removed en bloc or using the piecemeal technique.…”

“…Their precise incidence is underreported in the literature. Few studies have been published on skull metastases in the literature (Harrison et al, 2018;Nasi-Kordhishti et al, 2021;Ozgiray et al, 2016;Stark et al, 2003). Multiple therapeutic modalities are used in the treatment of cranial metastases: radiotherapy, surgery, and chemotherapy.…”